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This week, we are celebrating Asian American, Native Hawaiian, and Pacific Islander Breastfeeding Week was created in 2021 by the Asian Pacific Islander Breastfeeding Task Force. This year, the theme is: Better Data, Better Care for AANHPI Families. This week is celebrated annually from August 15-21.



The mission of this dedicated week is to decrease inequities and normalize chest/breastfeeding in AANHPI communities by improving breast/chestfeeding education and support practices.



This week will explore why data equity matters for AANHPI families by examining the current maternal and child health data landscape, highlighting California statewide efforts to improve data collection and representation, and uplifting community perspectives on what better data should look like.



Join these efforts by registering for a two-hour webinar on data equity and breastfeeding among AANHPI families discussing why data equity matters and current approaches to addressing gaps. The conversation will feature community voices discussing community strengths and challenges, how to support families, and how to work respectfully with communities.



🗓️ Tuesday, August 18, 2026

⏰ 11:00 AM to 1:00 PM PDT




This webinar is free to attend, please register here.

We are celebrating Indigenous Milk Medicine Week this week (August 8-14)! The 2026 theme is – Keep the Fires Lit: Rising Through Milk Medicine.



Indigenous Milk Medicine Week was created in 2019 by the Indigenous Milk Medicine Collective and is celebrated annually from August 8-14. Formerly known as Native Breastfeeding Week, the observance was created to encourage and uplift the diversity of Native breast/chestfeeding experiences.



Join the collective for their first ever, in-person convening dedicated to Indigenous lactation, community knowledge, and collective care. If you are interested in presenting at this event, their flyer contains information about “Request for Proposals” to review. The convening will take place on November 9-11, 2026 in Oklahoma City, OK. Save the date!

This year, the World Breastfeeding Week campaign focuses on what works when helping families and their babies have a sustainable start in life. The slogan “recognises that globally, exclusive breastfeeding has reached 47%, close to the World Health Assembly’s 2025 target of 50%, which has now been extended.”(1) However, as of 2023, just 29.8% of babies in the U.S. are being breastfed exclusively for the first six months of life.(2)



The World Alliance for Breastfeeding Action (WABA) reports that, “while regions and countries face different contexts…the same core interventions keep working, and the same obstacles keep getting in the way.”(3) In their work to identify what has worked, skilled support and consistent standards in healthcare facilities is highlighted. Specifically, Baby-Friendly-aligned practices and competency-based training with verification results in less unnecessary supplementation with infant formula and better early initiation of breastfeeding. WABA later reports that healthcare facilities, professional associations and training institutions should adopt competency-based training and verification.



Competency verification is an assessment of an individual’s knowledge and skills using tools that observe and measure abilities and attitudes. At its core, the competency verification method seeks to measure the ability of a professional to apply their knowledge and skills in practical situations.(4) The assessment of critical thinking and interpersonal skills are key to a robust competency verification program. Measuring competency focuses on the verification or demonstration of knowledge, skill, behavior or attitude.(5) While education alone can contribute to some individuals reaching the goal of being able to be verified, it is not the best pathway solution to demonstrate and verify that an individual is truly capable of performing the behaviors required by their profession.



The training and certification philosophy behind the CLC®, ANLC® and ALC® certifications has been competency verification since inception, with the underlying belief that although general knowledge can be gained through classroom learning about health sciences and tested through written examinations, the application of that knowledge and when to apply those skills in directly observed scenarios or case study situations is a more valuable indicator of an individual’s ability to work as a LSP.

References:

(1) https://worldbreastfeedingweek.org/2026/wp-content/uploads/2026/07/Action-Folder_wbw2026.pdf

(2) https://www.cdc.gov/breastfeeding-data/survey/results.html

(3) Ibid

(4) Chapin EM, Chen C-H, Dumas L, et al. The Paradigm Shift in BFHI Step 2: From Training to Competency Verification. Journal of Human Lactation. March 2021. doi:10.1177/0890334421995098.

(5) Wright D. (2005). The Ultimate Guide to Competency Assessment in Health Care. Third Edition. Minneapolis: Creative Health Care Management.

We are officially in our first week of National Breastfeeding Month! Each week this month, ALPP will be sharing opportunities to celebrate, to learn and to share!

The first week of August is known as World Breastfeeding Week (WBW), and the theme is “Breastfeeding for a Sustainable Start in Life: Strengthen What Works.”

“WBW is celebrated every 1-7 August in commemoration of the 1990 Innocenti Declaration. WBW started in 1992, with annual themes including healthcare systems, women and work, the International Code of Marketing of Breastmilk Substitutes, community support, ecology, economy, science, education and human rights. Since 2016, WBW is aligned with the Sustainable Development Goals (SDGs). In 2018, a World Health Assembly resolution endorsed WBW as an important breastfeeding promotion strategy.”



You can learn more about WBW here!

ALPP submitted their letter of complaint on 7/22/2026. A copy of that later can be found below:



UnitedHealthcare

Attn: Reimbursement Policy Department

Commercial Reimbursement Policies

950 Winter Street, Suite 3800, Waltham, MA 02451

Re: Objection to revision of HCPCS S9443 in the June 2026 Commercial Reimbursement Policy Update Bulletin (Preventive Medicine and Screening Policy, Professional), effective September 1, 2026
To the Reimbursement Policy Committee:



In June 2026, a reimbursement bulletin was shared on the United Healthcare (“UHC”) website announcing that, as of September 1, 2026, the reimbursement structure for lactation care (code S9443) would be changing.(1) According to that bulletin, code S9443 can be considered for reimbursement when the mother is the patient, but will not be considered for reimbursement for an infant as the patient. In other words, code S9443 will be reimbursed for one session per date of service.



The Academy of Lactation Policy and Practice ‘s (“ALPP”) vision is a world where all families have access to quality, interdisciplinary, culturally sensitive lactation care, thereby promoting, protecting and supporting breastfeeding and lactating individuals around the world. This is only possible if there is access to all types of lactation support providers (“LSPs”), in various settings, across all geographic areas.



The American Academy of Pediatrics (“AAP”) states that breastfeeding and human milk are the normative standards for infant feeding and nutrition. The AAP supports exclusive breastfeeding for the first 6 months of life, and continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired for 2 years or beyond. Human milk has a unique composition, with antimicrobial, anti-inflammatory, immunoregulatory agents, and living leukocytes, all of which contribute to the developing immune system of the child. Studies and meta-analyses have confirmed the association of 6 months of exclusive breastfeeding with decreased rates of lower respiratory tract infections, severe diarrhea, otitis media, and obesity in for infants and young children. Additionally, studies and meta-analyses have confirmed the impact of breastfeeding longer than 12 months on maternal health in decreasing maternal type 2 diabetes mellitus, hypertension, breast cancer, and ovarian cancer rates.(2)




A 2025 National Academies report made recommendations to promote and support breastfeeding, including a national strategy to ensure families have access to breastfeeding support. That same report concluded: “CMS, the Federal Insurance Office, and public and private payers should create and ensure comprehensive coverage and payment of breastfeeding services and supplies to guarantee equal access to [lactation support].”(3)



Payer policy guidance generated by the U.S. Breastfeeding Committee (“USBC”) suggests that, while the Affordable Care Act (“ACA”), enacted over a decade ago, was intended to be a sweeping reimagining of how public health infrastructure and healthcare delivery may be integrated [to help new families]…breastfeeding has been difficult for many insurers to fit into existing delivery models.”(4) UHC was one of several commercial insurance companies that began reimbursing for lactation support services in some states across the U.S following the ACA implementation. Despite a low reimbursement rate, this type of recognition for services that are desperately needed for new families was beneficial to both families and LSPs.



The recently announced policy coverage update, stating that UHC reimburse for lactation support services with the mother as the patient, but will not consider reimbursement for the infant, fails to recognize the science of the breastfeeding dyad, the comprehensive nature of lactation support and the role that breastfeeding plays for public health and wellbeing. As the Maine State Breastfeeding Coalition points out, “such a policy is nonsensical to the model of care that [lactation support professionals] offer, [as] few if any breastfeeding concerns do not involve the infant. Most sessions center around an assessment of the baby’s latch and milk transfer to the baby.”(5) Under this updated policy, UHC will not reimburse providers any longer for that crucial aspect of their work.



The (AAP) and the American College of Obstetricians and Gynecologists (ACOG) recommend assessing the mother-baby dyad as an integrated unit to support postpartum recovery, successful breastfeeding, and early childhood development.(6) The Academy of Breastfeeding Medicine (“ABM”) recommends that the dyad have an office or in-home visit with a lactation professional for the term infant.(7) These best practices require the infant to be present with the parent and the feeding to be observed. They also recommend continued follow-up for any infants with ongoing breastfeeding issues.



At a time when significant reimbursement challenges for healthcare professionals, and particularly for maternal and child health care providers, already exist and are causing major issues in accessing care, we need insurers to acknowledge the critical importance of breastfeeding and those professionals who support new families on their breastfeeding journeys. Chronic underpayment of lactation professionals has long been an issue, but further cuts to reimbursement rates threaten the ability of these professionals to continue their work all together. Our families cannot be successful with breastfeeding, and our babies cannot be given the best possible start to life, when insurance companies decide that reimbursing for this critically important work is no longer worth it.



ALPP urges UHC to reconsider this policy change, and to allow the use of CPT codes that cover both the mother and the baby in breastfeeding assessments and care, and that do not result in additional co-pays or deductibles.



ALPP requests that UHC withdraw its provision for excluding infant claims for CPT code S9443, and to continue to reimburse this code for both members of the breastfeeding dyad (mother and baby) when each is individually assessed. Alternatively, the creation of a new CPT code for a breastfeeding dyad assessment and support, which is reimbursed at a higher rate that code S9443, could serve as a solution.



ALPP requests the UHC withdraw the limit on one session per date of service language.



ALPP requests that UHC confirms that lactation support and counseling will continue to be covered by their health insurance policies as a preventive service without cost-sharing requirements.



ALPP would welcome the chance to engage in this conversation further, and thanks you for your time to reconsider these changes in the name of what is best for families and their babies.



Sincerely,



Ellie Mulpeter, MPH

Director, Academy of Lactation Policy and Practice

PO Box 2160

South Dennis, MA 02660



1. https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/rpub/UHC-COMM-RPUB-June-2026.pdf

2. Joan Younger Meek, Lawrence Noble, Section on Breastfeeding; Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics July 2022; 150 (1): e2022057988. 10.1542/peds.2022-057988

3. https://www.nationalacademies.org/news/to-improve-breastfeeding-rates-in-us-report-recommends-creating-national-strategy-enacting-paid-federal-family-and-medical-leave

4. https://web.usbreastfeeding.org/External/WCPages/WCWebContent/webcontentpage.aspx?ContentID=2409

5. https://www.mainebreastfeeds.org/blog/united-healthcare-billing-changes

6. COMMITTEE ON FETUS AND NEWBORN; Hospital Stay for Healthy Term Newborns. Pediatrics February 2010; 125 (2): 405–409. 10.1542/peds.2009-3119

7. https://www.bfmed.org/protocols

Congresswoman Gwen Moore (D-WI), Senators Elizabeth Warren (D-Mass.) Cory Booker (D-N.J), and Congresswomen Ayanna Pressley (D-Mass.), Lauren Underwood (D-Ill.), Alma Adams (D-N.C.) introduced the Mamas First Act, which would expand access to maternal health care for mothers who rely on Medicaid.



“Across this nation, 40 percent of moms depend on Medicaid when they give birth. Instead of gutting and sabotaging Medicaid, we need to strengthen it so we can save lives. The Mamas First Act would provide mothers with access to evidence-based supportive care that can lead to healthier outcomes for them and their babies. At a time when stark disparities in maternal mortality continue to hit our communities hard, I am thrilled to have such incredible colleagues and advocates supporting the Mamas First Act and the ongoing fight to save lives,” said Congresswoman Gwen Moore.



This bill serves as a bold step to address our country’s maternal mortality crisis by expanding Medicaid coverage to include doula, midwife, and lactation care.



The Mama’s First Act will require Medicaid coverage of all types of lactation professionals who have completed at least 20 hours of foundational training based on the World Health Organization/United Nations Children’s Fund lactation counseling training blueprint, or an equivalent training; or is recognized within any category on the Lactation Support Provider Descriptor chart published by the U.S. Breastfeeding Committee-affiliated Lactation Support Provider Constellation.



The full text of the legislation can be found here. ALPP will continue to share legislative advocacy opportunities with its certificants as this bill moves forward.

UPDATE: ALPP’s Director, Ellie Mulpeter, was contacted on July 8, 2026 by PGBA (Palmetto Government Benefits Administrator) an insurance administration and claims processing company. They notified ALPP that the claims being denied were a result of a system error, which has since been corrected. They also notified ALPP that all claims that were incorrectly denied are being re-processed as high priority claims. If any lactation professionals face future denials of claims using CPT Codes 99401 to 99404, those professionals should contact ALPP for further assistance at: info@alpp.org

A copy of ALPP’s letter, sent on Thursday July 2, 2026, can be found below:



To TRICARE West, TRICARE East, TRICARE Overseas, PGBA and the Defense Health Agency,



The Academy of Lactation Policy and Practice (“ALPP”) has been notified of a pattern of denial of claims for lactation counseling and lactation consulting across all TRICARE regions – directly and negatively impacting military families across the U.S. and overseas. Reimbursement for lactation services is a required benefit under the TRICARE childbirth and breastfeeding support demonstration (“CBSD”) project. Per that project, TRICARE recognizes lactation counseling as good clinical practice, and commits to covering breastfeeding counseling at no cost when provided inpatient, outpatient and during well-child care visits, for up to six separate outpatient sessions, as a preventative service. Lactation support services are to be provided by International Board Certified Lactation Consultants (“IBCLC®”) and Certified Lactation Counselors (“CLC®”).



Per Chapter 18 of the TRICARE Operation Manual for the CBSD project, “The contractor shall reimburse individual lactation counseling sessions under the existing TRICARE breastfeeding support benefit, at the non-physician, non-facility CHAMPUS Maximum Allowable Charge (“CMAC”) under the existing Current Procedural Terminology (“CPT”) codes 99401 to 99404.”[1] Meanwhile, we have evidence of a systematic pattern of TRICARE claim denials, beginning in May 2026, for services billed under CPT Codes 99401-99404, with no legitimate policy basis.



Breastfeeding support is critical after a mother and baby leave a hospital or birth center following childbirth. The majority of individuals seek follow-up care, support and guidance for how to successfully sustain and maintain breastfeeding their baby. The public health benefits of breastfeeding are vast. Empirical data has shown that exclusive breastfeeding for 6 months, and continued breastfeeding alongside complementary foods for two years or beyond can prevent the following cases among infants and young children:



• 45,298 cases of childhood obesity[2]

• 601,825 ear infections in children[3]

• 1,355 cases of necrotizing enterocolitis[4]



Optimal breastfeeding could also reduce diseases among women by preventing:



• 5,023 cases of breast cancer[5]

• 12,320 cases of Type 2 diabetes[6]

• 5,982 cases of hypertension[7]



The value of the CBSD project cannot be understated for military families, but it will only be beneficial to military families if its own payment and claims systems are consistent and reliable. Lactation professionals consistently have to advocate for reimbursement of their services and time, and typically have to settle for a reimbursement amount that does not adequately align with the work they are doing. The CBSD project cannot fall into this same pitfall. There is no reason why these claims are being denied.



Military members and their families already sacrifice for our country; they should not have to sacrifice being able to receive the care that the DHA have committed to. We urge TRICARE to reverse the denials of claims for codes 99401 to 99404 that have been issued over the past two, successive months. We urge TRICARE to allow the use of billing codes, as outlined in their manuals, or to issue clear guidance on which codes lactation professionals should use under the CBSD project, while setting an effective date for the change in the future, and honoring the use of “grandfathered” CPT codes for a set period of time.



Sincerely,

Ellie Mulpeter, MPH

Director, Academy of Lactation Policy and Practice

E: info@alpp.org





[1] https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-03-18/AsOf/TO15/C18S11.html

[2]Finkelstein, E.A., Graham, W.C., & Malhotra, R. (2014). Lifetime direct medical costs of childhood obesity. Pediatrics, 133(5): 854-62.

[3]Ahmed, S., Shapiro, N., & Bhattacharyya, N. (2014). Incremental health care utilization and costs for acute otitis media in children. The Laryngoscope, 124(1): 301-305.

[4]Neu, J. & Walker, A. (2011, January 20). Necrotizing Enterocolitis. The New England Journal of Medicine, 364: 255-264.

[5]Farina, K. (2012, March 16). The Economics of Cancer Care in the United States. American Journal of Managed Care. Retrieved from www.ajmc.com/journals/evidence-based-oncology/2012/2012-2-vol18-n1/the-economics-of-cancer-care-in-the-united-states-how-much-do-we-spend-and-how-can-we-spend-it-better

[6]Zhuo, X., Zhang, P., & Hoerger, T.J. (2013, September). Lifetime direct medical costs of treating type 2 diabetes and diabetic complications. American Journal of Preventive Medicine, 45(3): 253-61.

[7]Davis, K. (2013, April). Expenditures for Hypertension among Adults age 18 and Older, 2010: Estimates for the U.S. Civilian Noninstitutionalized Population. Statistical Brief #404, Agency for Healthcare Research and Quality. Retrieved from meps.ahrq.gov/data_files/publications/st404/stat404.shtml

The Maternal Child and Reproductive Health (MCRH) Team at the Colorado Department of Health Care Policy and Financing (HCPF) would like to inform Maternal Health stakeholders about the upcoming opportunities to engage in the Medicaid Provider Rate Review process.



The Medicaid Provider Rate Review Advisory Committee (MPRRAC) is a legislatively established advisory committee that assists HCPF in reviewing provider reimbursement rates within Health First Colorado (Colorado’s Medicaid program). Each year, the MPRRAC focuses on a particular scope based on services under review for that year. As part of HCPF’s ongoing rate review process, MPRRAC reviews data, stakeholder feedback, and recommendations related to Medicaid provider reimbursement rates and provides input to the Department and the Joint Budget Committee.



Several maternal health services are under review as part of the current cycle, including Doula and Lactation Support Services.



Input from providers, community organizations, advocates, and individuals with lived experience is an important part of the rate review process. Stakeholders interested in sharing feedback are encouraged to participate in upcoming public meetings.



The next public meetings will be held on:

Friday, June 26 (Part 1): 9 a.m. to 2 p.m.

Friday, July 10 (Part 2): 9 a.m. to 2 p.m.

Information about how to join these meetings and the process overall can be found here.



Certified Lactation Counselors (CLCs) in Colorado should absolutely consider attending these public meetings, and making public comments as needed, in order to advocate for the reimbursement of all lactation support professionals in Colorado. Currently, Colorado Medicaid recognizes CLCs, CLEs, and IBCLCs as enrolled providers. With your voice and advocacy, you can help to ensure that Medicaid-covered maternal health services continue to meet the needs of Colorado families.

In Early May, 2026, two bills were heard before the Rhode Island Legislature relating to insurance coverage of Certified Lactation Counselors (CLCs) who are licensed by the state.



House Bill 8175 focused on Medicaid insurance coverage and would mandate Medicaid coverage for services provided by licensed CLCs in Rhode Island. This bill, sponsored by Representative Stewart, would ensure that the reimbursement rate for CLCs would be comparable to other maternal and child health providers, and also would prohibit imposing unique supervision or referral requirements for licensed CLCs.



Meanwhile, Senate Bill 2383 focused on private and public health insurers – requiring both types of policies to cover services provided by licensed CLCs. The Senate bill, introduced by Senator Mack would also prohibit insurers from requiring supervision or referral by another health care provider as a condition of reimbursement for lactation counselor services, unless such requirements apply to other provider categories.



Both of the proposed bills would require health insurers to annually report utilization and cost information for covered lactation counselor services to the office of the health insurance commissioner, which is a beneficial component for collecting public health data in Rhode Island.



These two bills were heard early in May before their respective Committees and have since been held for further study. This does not indicate that the bills will not pass this session, but does delay the process. To the best of our understanding, this vote of the committees means an indefinite postponement at this time. ALPP will continue to monitor the progress and status of these two, important public health bills.

California Assembly Bill 2160 was introduced by Assemblywoman Celeste Rodriguez in February of 2026. The bill would require Medi-Cal, California’s Medicaid program, to allow International Board Certified Lactation Consultants (IBCLCs) to enroll directly as Medi-Cal providers and bill for lactation services directly. The bill also seeks to have Medi-Cal clarify their existing coverage policies for all lactation services provided throughout the state, by many different types of lactation support professionals.



Alongside our colleagues at HealthConnect One – a national leading organization in advancing equitable, community-based, peer-to-peer support for pregnancy, birth, breastfeeding, and early parenting, ALPP has persistently advocated for the inclusion of all lactation support professionals in this policy, since its introduction. We have met with the office of the bill’s sponsor, as well as members of the California Breastfeeding Coalition and California WIC Association who are co-sponsoring this bill. Despite those meetings, AB 2160 remains focused on encouraging Medi-Cal provider enrollment for IBCLCs only.



We firmly believe that AB 2160 should include all skilled lactation support providers, including Breastfeeding Peer Counselors, CLCs and ALCs, etc. in the field – not just one type of lactation consultant. As evidenced by the U.S. Breastfeeding Committee’s Lactation Support Provider Descriptor Chart (1), lactation consultants, lactation counselors, lactation educators, breastfeeding specialists, peer counselors, military lactation counselors and indigenous lactation counselors all provide necessary and culturally relevant support for families who are hoping to breastfeed. All of these provider types work within their own Scope of Practice and readily refer families to other provider types when needed.



As noted by HealthConnect One’s issue brief, “While the California AB 2160 lactation bill aims to strengthen access to lactation services, the current language limits recognized providers… This narrow definition: excludes the community-based workforce that families trust and rely on most; creates barriers to access, particularly for Black, Indigenous, immigrant and low-income
families; and reinforces inequities by prioritizing credentialing structures over culturally congruent care. This omission is not simply a gap; it is a structural barrier that risks limiting the effectiveness and reach of Medi-Cal lactation services.” (2)



As the research shows, rates of breastfeeding initiation and continued breastfeeding are much lower among families who are insured by Medicaid compared to those who are commercially insured. (3) In order to adequately support all of the families in California that wish to breastfeed, we need to incentive access to as many qualified providers as possible. This will not be achieved if only one type of lactation support provider is supported by Medi-Cal and enrolled as Medi-Cal providers, as is currently written by AB 2160.

AB 2160 is currently slated for a hearing by the Assembly Committee on Appropriations on Wednesday May 6, 2026. However, it is currently placed on the Consent Calendar, which means that public testimony on the bill is not being heard. This was the same process and procedure that occurred in the bill’s initial hearing by the Assembly Committee on Health. ALPP continues to submit written testimony to members of each committee hearing the bill to emphasize the importance of inclusivity in such policies.

References:

1. https://web.usbreastfeeding.org/External/WCPages/WCWebContent/webcontentpage.aspx?ContentID=5199

2. https://healthconnectone.org/wp-content/uploads/2026/04/Position-on-CA-Lactation-Bill-2160-April-10-2026-d-1.pdf

3. https://pubmed.ncbi.nlm.nih.gov/29634340/